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NPI Code Detail

MEDICARE: PETER BERK SMITH LPCC

MEDICARE: PETER BERK SMITH LPCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor286984KY

General Provider Information

NPI Number : 1356929160
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER BERK SMITH LPCC
Provider Business Mailing Address
First Line : 26922 STATE ROUTE 784
Second Line :
City : GRAYSON
State : KY
Zip : 41143-6565
Country : US
Telephone Number : 606-315-8822
Fax Number :
Provider Business Practice Location Address
First Line : 332 15TH ST
Second Line :
City : ASHLAND
State : KY
Zip : 41101-7626
Country : US
Telephone Number : 606-315-8822
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2021
Last Update Date : 08/07/2024

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Directions to “ PETER BERK SMITH LPCC” Practice Location

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